Lumbar spinal stenosis: methods of treatment with emphasis on epidural steroid injections

Background and Purpose: The aim of the study was to compare two techniques of steroid application into epidural space to patients with lumbar spinal stenosis (LSS), a chronic degenerative spine disorder. Patients and Methods: Sixty LSS patients have been distributed into 2 groups: “BLIND” (n=30, interlaminar epidural steroid injection without RTG control) and “RTG” (n=30, transforaminal epidural injection with RTG control). All patients have received 80 mg of triamcinolon (Kenalog) into epidural space on L4/L5 level, together with 0,5% lidocain (patients in RTG group 3 ml and those in BLIND group 10 ml) in 3 week intervals. They were asked to describe the pain using visual analogue scales (VAS) at the beginning of treatment (VAS-0), after the first (VAS-1), the second (VAS-2) and the third epidural injection (VAS-3). The differences between groups were shown using t-test (age) and c2-test (gender). Medians of VAS scores were statistically described using non parametrial methods. P<0.05 was considered as a statistically significant. Results: There is no statistical difference among patients regarding to age (P=0.93), gender (P=0.12) and VAS-0 score before the first injection (P=0.27). There is a statistically significant reduction of pain in relation to VAS-0 in both groups (P<0.001). Both groups do not statistically differ when it comes to their effectiveness in regards to VAS scores. Conclusions: We did not find any statistical difference in postinterventional VAS scores among two groups of patients. Choice of technique depends on the experience of the anesthesiologist, as well as on the local technical possibilities (availibility of RTG devices)

Global health partnerships: building multi-national collaborations to achieve lasting improvements in maternal and neonatal health

Abstract Background In response to health care challenges worldwide, extensive funding has been channeled to the world’s most vulnerable health systems. Funding alone is not sufficient to address the complex issues and challenges plaguing these health systems. To see lasting improvement in maternal and infant health outcomes in the developing world, a global commitment to the sharing of knowledge and resources through international partnerships is critical. But partnerships that merely introduce western medical techniques and protocols to low resource settings, without heeding the local contexts, are misguided and unsustainable. Forming partnerships with mutual respect, shared vision, and collaborative effort is needed to ensure that all parties, irrespective of whether they belong to resource rich or resource poor settings, learn from each other so that meaningful and sustained system strengthening can take place. Methods In this paper, we describe the partnership building model of an international NGO, Kybele, which is committed to achieving childbirth safety through sustained partnerships in low resource settings. The Kybele model adapts generic stages of successful partnerships documented in the literature to four principles relevant to Kybele’s work. A multiple-case study approach is used to demonstrate how the model is applied in different country settings. Results The four principle of Kybele’s partnership model are robust drivers of successful partnerships in diverse country settings. Conclusions Much has been written about the need for multi-country partnerships to achieve sustainable outcomes in global health, but few papers in the literature describe how this has been achieved in practice. A strong champion, support and engagement of stakeholders, co-creation of solutions with partners, and involvement of partners in the delivery of solutions are all requirements for successful and sustained partnerships

Global health partnerships: building multi-national collaborations to achieve lasting improvements in maternal and neonatal health

Abstract Background In response to health care challenges worldwide, extensive funding has been channeled to the world’s most vulnerable health systems. Funding alone is not sufficient to address the complex issues and challenges plaguing these health systems. To see lasting improvement in maternal and infant health outcomes in the developing world, a global commitment to the sharing of knowledge and resources through international partnerships is critical. But partnerships that merely introduce western medical techniques and protocols to low resource settings, without heeding the local contexts, are misguided and unsustainable. Forming partnerships with mutual respect, shared vision, and collaborative effort is needed to ensure that all parties, irrespective of whether they belong to resource rich or resource poor settings, learn from each other so that meaningful and sustained system strengthening can take place. Methods In this paper, we describe the partnership building model of an international NGO, Kybele, which is committed to achieving childbirth safety through sustained partnerships in low resource settings. The Kybele model adapts generic stages of successful partnerships documented in the literature to four principles relevant to Kybele’s work. A multiple-case study approach is used to demonstrate how the model is applied in different country settings. Results The four principle of Kybele’s partnership model are robust drivers of successful partnerships in diverse country settings. Conclusions Much has been written about the need for multi-country partnerships to achieve sustainable outcomes in global health, but few papers in the literature describe how this has been achieved in practice. A strong champion, support and engagement of stakeholders, co-creation of solutions with partners, and involvement of partners in the delivery of solutions are all requirements for successful and sustained partnerships